Pathogenesis, Diagnosis, and Management of Reflux Esophagitis

The most common symptoms associated with reflux esophagitis are heart­ burn and regurgitation. Heartburn is usually described as a substernal or retrosternal burning pain or discomfort with a moving quality from the xyphoid area up toward the suprasternal notch. The pain may radiate up toward the neck and jaw as well as down into the epigastric area. Rarely, the pain may radiate into the arms and simulate the pain of cardiac origin (1). Heartburn is frequently associated with regurgitation of sour or bitter fluid. These symptoms are exacerbated by meals or postural changes, usu­ ally made worse when the patient is recumbent or tenses his abdominal muscles as in lifting. Most patients (84%) experience symptoms of reflux for more than one year before seeking medical attention (2). Intermittent dysphagia occurs frequently with the first swallows of every meal. The symptom is often reported by patients with severe reflux eso­ phagitis. They do not often have mechanical obstruction to the passage of food. Usually the dysphagia will be mild and nonprogressive with no asso­ ciated weight loss. This is the result of a motility disturbance within the body of the esophagus induced by reflux of gastroduodenal contents (3) and occurs most frequently with the first bolus swallowed. Persistent dysphagia of solids in a patient with reflux esophagitis should indicate to the clinician that a peptic stricture has formed or that a carcinoma may have developed within the esophagus. Anemia has been described as the presenting symp­ tom in some patients with reflux esophagitis; it is a result of low-grade